Abstract
Aims: To investigate high-risk sociodemographic and environmental determinants of health (SEDH) potentially associated with adult obesity in counties in the United States using machine-learning techniques. Materials and Methods: We performed a cross-sectional analysis of county-level adult obesity prevalence (body mass index ≥30 kg/m2) in the United States using data from the Diabetes Surveillance System 2017. We harvested 49 county-level SEDH factors that were used in a classification and regression trees (CART) model to identify county-level clusters. The CART model was validated using a ‘hold-out’ set of counties and variable importance was evaluated using Random Forest. Results: Overall, we analysed 2752 counties in the United States, identifying a national median (interquartile range) obesity prevalence of 34.1% (30.2%, 37.7%). The CART method identified 11 clusters with a 60.8% relative increase in prevalence across the spectrum. Additionally, seven key SEDH variables were identified by CART to guide the categorization of clusters, including Physically Inactive (%), Diabetes (%), Severe Housing Problems (%), Food Insecurity (%), Uninsured (%), Population over 65 years (%) and Non-Hispanic Black (%). Conclusion: There is significant county-level geographical variation in obesity prevalence in the United States, which can in part be explained by complex SEDH factors. The use of machine-learning techniques to analyse these factors can provide valuable insights into the importance of these upstream determinants of obesity and, therefore, aid in the development of geo-specific strategic interventions and optimize resource allocation to help battle the obesity pandemic.
Original language | English (US) |
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Pages (from-to) | 1766-1774 |
Number of pages | 9 |
Journal | Diabetes, Obesity and Metabolism |
Volume | 26 |
Issue number | 5 |
DOIs | |
State | Published - May 2024 |
Keywords
- machine learning
- obesity prevalence
- public health
- Geography
- United States/epidemiology
- Prevalence
- Cross-Sectional Studies
- Humans
- Obesity/epidemiology
- Adult
- Diabetes Mellitus
ASJC Scopus subject areas
- Internal Medicine
- Endocrinology, Diabetes and Metabolism
- Endocrinology